Smoking killed Princess Leia

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Stan Glantz, PhD, as featured in
the 2014 documentary movie
Merchants of Doubt

Stanton “Stan” Glantz, PhD, a professor at UCSF School of Medicine in San Francisco, CA, has been a tireless campaigner for smoke-free air for decades, and bitter opponent of the tobacco industry. His interests more recently include smoking in movies, identified as encouraging smoking initiation.

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Dr. Stuart Kreisman

In a  January 5th, 2017, e-mail from Stan Glantz to his list he applauds Stuart H. Kriesman, MD, on the Faculty of Medicine at the University of British Columbia, Vancouver, Canada, for an excellent just-published opinion piece titled:
Princess Leia ultimately killed by the real Darth Vader
.

Dr. Kreisman begins by reminding us of why smoking continues to be such a major health problem, “accounting for 10% of all Canadian deaths, and kills more people than alcohol, drugs, car accidents, murder, suicide, and AIDS combined.” He notes how the tobacco industry has reacted to the need to find new customers, focusing its efforts on addicting teens, with movies being “one of the main legal avenues remaining for the industry to (indirectly) market to children.”

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Carrie Fisher in Star Wars

He adds: “Numerous studies have shown that smoking in movies makes teens more likely to try smoking,” accounting for nearly 40% of youth smoking initiation.

Dr. Kriesman notes that Carrie Fisher was a lifelong smoker. “She had also fought mental health and addiction battles, smoking prevalence being disproportionately elevated in both of these groups.” He concludes that smoking was likely the cause of her death on December 27, 2016, at age 60 from a sudden heart attack.

(Stan Glantz notes that “Most people don’t know that smoking causes heart attacks.” There was no such connection made in news reports I saw or read in the case of Carrie Fisher. However, a Google search of “Carrie Fisher’s heart attack due to smoking” did include such mention in a USA Today article, which added that “diabetes, lack of exercise and obesity are more potent risks in women.”)

Dr. Kriesman’s OpEd suggests many opportunities for action against the tobacco industry, such as increasing the age limit for tobacco product purchases to 21. This is something which St. Louis County Councilman Sam Page, M.D. successfully accomplished in September 2016, with bipartisan support. That was followed shortly afterwards by the City of St. Louis approving a similar bill sponsored by Alderwoman Dionne Flowers.

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Actress Debbie Reynolds with daughter Carrie Fisher. Ms Reynolds died from a stroke the day after her daughter’s death, attributed to grief.

Dr. Kriesman’s OpEd concludes:
“Most importantly, recruit Hollywood’s help and take control of smoking’s image — show that it truly is not cool, but instead, a never-ending beauty-and-health-destroying, poverty-inducing, pathophysiological battle against nicotine withdrawal that mostly traps society’s weakest (and least enviable) members.

Maybe Princess Leia can help us defeat true organized evil after all.

Stan Glantz features Dr. Kriesman’s blog on the Smoke Free Movies blog at https://smokefreemovies.ucsf.edu/blog/smoking-killed-princess-leia and @SmokeFreeMovies and @ProfGlantz.

1993-01-14 P-D: “County’s Plan To Curb Smoking Burns Some Workers” & parody

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Virgil Tipton, May 2013

On January 14th, 1993, then St. Louis Post-Dispatch staff reporter, Virgil Tipton, wrote a story about smoking employees faced with curbs on smoking in the County Government Center in Clayton, an effort spearheaded by former St. Louis County Councilman Kurt Odenwald. I thought the tone was overly sympathetic to the smokers, and wrote to Mr. Tipton expressing my concerns, to which he was good enough to reply. Subsequently, I wrote a parody, substituting alcohol for cigarettes, and sent it to him.
While tidying up recently, which I do every decade or so, I discovered both the original story on page 3A and the (unpublished) parody in my letter to Mr. Tipton. I reproduce both below for your enjoyment, preceded by part of my letter to him.

Excerpt from Martin Pion’s letter to Virgil Tipton:
“Before you read on, I should say that I don’t think you handled the story any differently from the average reporter, but that’s the problem.
Suppose instead you were doing a story on drunken drivers, and a new county law proposing stiffer regulations. But instead of seeking out the survivors of collisions with drunken drivers, or the families of deceased victims, you instead went into bars looking for drunken drivers, or stopped a drunk about to get into a car and drive off, and interviewed those individuals to gauge the effect of the new law. And the picture you ran was not of the victims of drunken drivers, but drunken drivers themselves knocking back beers in a bar. In fact, the story would more or less focus on drunken drivers, and show them as the victims. It might run something like this:” (Please see below newspaper article.)

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County’s Plan To Curb Smoking Burns Some Workers
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______________________________________________________
County Plan Means Trouble Brewing for Drunken Drivers
By Virgin O. N. Tipsy*
Of the Post-Dispatch staff

Two things were coming to a head in the county bar Wednesday. One was Caverne Burpp’s beer. The other was Caverne Burpp because of further restrictions proposed by the county council on drunken driving. Burpp claimed the proposals were nothing short of discriminatory. Burpp said trucks and speeders caused more deaths and accidents than drunken drivers. “All they get is a slap on the hand – and that’s the end of it,” Burpp said. “What will be our next right taken away?”
The proposal, expected to be introduced at today’s council meeting, would ban drunken drivers on county roads, including those around the airport, except on specially designated roads with guard rails to separate them from non-drunken drivers.
Under the county’s current ordinance, drunken drivers can drive only in the outside lane of all county roads, except when passing.
The backdrop to this measure is a report issued last week by the Department of Transportation. The report says that drunken driving is responsible for almost 20,000 road deaths a year.
The idea of the measure is obvious – to keep drunken drivers away from sober drivers, said Councilman Curt S. See, who is proposing the measure.
“When drunken drivers drive on public highways, they are a hazard to those who don’t drive drunk and who don’t want their lives endangered,” said See.
See said drunken drivers would not lose out entirely because the measure allows for some designated drunken driver lanes with guard rails.
“I do think that people who drive drunk have some rights, at least, that’s how I see it” See said.
But if setting up separate lanes for drunken drivers proves impossible, See said he would move ahead with the measure anyway. In that case, drunken drivers would still be permitted to drive drunk, provided they didn’t do it on county roads.
During the happy hour at a tavern near the St. Louis County Council Government Center on Wednesday, drunken drivers put away pints of draught while vowing to put away See’s proposal.
“It’s not fair,” said Tipsy Todd of Florissant. “I don’t tell people not to pass me because I don’t like being passed. If I didn’t drive drunk I’d feel the same way.”
Across from the The Drunken Drivers’ Tavern, in a hospital emergency room, Bev E. Rage quietly celebrated on a soda.
Rage, who quit drunken driving three years ago after being involved in a near-fatal collision, recently ended up in the hospital again after being hit by a drunken driver that morning. She said she had her car reinforced front and back but was hit broadside at a stop light.
“I think they should have a place to drive drunk – but I think it should be separated by a guard rail,” Rage said. “They can drive stoned 200 miles a day if they want, but I don’t want them coming at me.”

*A parody, by Martin Pion

Beetle Bailey’s former smoker, Private Rocky, evokes my late sister’s memory

Back on May 12th, 2016, a Beetle Bailey comic strip appeared in the daily St. Louis Post-Dispatch that caught my eye and I added it to the newspaper pile on my office floor. That’s where it stayed until I recently did some office cleaning. The strip featured Private Rocky, described on-line as follows:

Camp Swampy’s long-haired, disgruntled social dissident; a former biker gang member and rebel-without-a-clue, introduced to the “BEETLE BAILEY” comic strip in 1958. This dude probably got into the US Army via a court order, where he was told, “Join up, or go to prison!” Definitely, he was a malcontent from “the wrong side of the tracks.” 

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Beetle Bailey – By Mort and Greg Walker, St. Louis Post-Dispatch 5-12-2016

In this particular strip, Rocky is reminiscing from the days before he quit smoking and in the strip it’s funny. But it reminded me of a very unpleasant personal encounter with a cigar smoker after I had asked him to quit smoking in an airport area signed “No Smoking.”  Ironically, at the time I was flying to see my non-smoking sister living in England dying of lung cancer.

The above strip has awakened my memory of that devastating personal event, since I loved and revered my sister and only sibling enormously. Afterwards I wrote a personal account of the event, thinking I might submit it for publication, but I never did. I’ve lost the original computer file but below is a copy of the printed version for anyone interested. (And my apologies in advance for the five page length.)

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2016-11-28: A look back at Amendment 3

Amendment 3, which aimed to raise Missouri’s lowest-in-the nation cigarette tax by 60 cents a pack over four years, went down to defeat, 59.2% to 40.8% (or 1,609,953 votes to 1,107,716) on November 8th, 2016. At least 75% of the money raised was to have been dedicated to early childhood education programs, said to be currently underfunded, with some also going to early childhood health and smoking prevention programs. It would have closed a tax loophole which presently allows smaller tobacco companies not part of the Master Settlement Agreement to sell more competitively in the state.

The primary organizers of Amendment 3, Raise Your Hands for Kids, received $12.1 million of its nearly $13 million in contributions from Reynolds American tobacco. This was partly responsible for generating opposition from many tobacco control and smoke-free air advocacy groups, among others.

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Ron Leone

The amendment was also opposed by the Missouri Petroleum Marketers and Convenience Store Association, led by Executive Director Ron Leone. It wanted to protect the tax loophole currently enjoyed by smaller tobacco brands to maintain profits, and spearheaded a competing proposal, Proposition A.

This was for a more modest cigarette tax increase in increments totaling only 23 cents a pack by 2021 with revenue being deposited in the state’s Transportation Infrastructure Fund.

According to Ballotpedia, two tobacco companies benefiting from the current tobacco tax exemptions, Cheyenne International and XCaliber International donated a combined $4.8 million to the PAC supporting Proposition A and opposing Amendment 3.

On November 8th, Proposition A was defeated 55.3% to 44.7% (1,494,886 votes to 1,210,199).

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Dr. Anthony Pearson

There were strong arguments in favor of Amendment 3, such as those featured in an in-depth blog called The Skeptical Cardiologist by Anthony C. Pearson, M.D., of St. Luke’s Hospital in St. Louis.

Reviewing them makes me wonder if the defeat of Amendment 3 wasn’t a significant lost opportunity. At the same time, I believe the funding should have been specifically dedicated to reducing smoking prevalence in the state by proven successful advertising campaigns and helping smokers quit. Also the entire proposed cigarette tax increase – preferably a dollar rather than 60 cents – needed to go into effect at once, and not be spread over four years in 15 cent increments.

2016-11-03 StLotA: “Election 2016: Pros and cons of Missouri’s Proposition A, the 23 cent proposed tobacco tax”

I just listened to today’s St. Louis on the Air, devoted to discussing the two tobacco tax increase proposals on the November 8th ballot. I thought that Stacy Reliford of the American Cancer Society gave a fine performance against smooth-tongued Ron Leone, Executive Director of the Missouri Petroleum Marketers and Convenience Store Association, despite his being well armed with facts.

But he did better in the second half of the broadcast when debating Jane Dueker, an attorney representing Constitutional Amendment 3 (sponsored by Raise Your Hands For Kids, or RYH4K), a group advocating for early childhood education.

So far, I can only find a link to the first half of the broadcast at tinyurl.com/zcz7n49 and I’ve reproduced that below. You can listen to the full broadcast by going to the above link and scrolling down.

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Ron Leone

Note: Ron Leone has changed quite a bit since the black and white photo I have of him on file (at left), which I used in my blog of November 1st. But he still has considerably more hair than me, and he doesn’t look so evil now!)

“On Tuesday, Nov. 1, St. Louis on the Air hosted a moderated conversation in the Community Room at St. Louis Public Radio about Amendments 3, 4 and 6 as well as Proposition A. This was an effort to inform voters on statewide ballot issues they would see on Nov. 8.

The third part of the conversation centered on Proposition A, which would increase taxes on cigarettes and other tobacco products a total of 23 cents per pack by 2021. The proceeds of the tax would go to fund transportation infrastructure.

This measure is one of two tobacco tax-related measures on Missouri’s ballot. The other is Constitutional Amendment 3.

During this part of the conversation, we heard from one proponent and one opponent of Proposition A. Ron Leone, executive director of the Missouri Petroleum Marketers & Convenience Store Association, represented the “pro” side of the argument. Stacy Reliford, the Missouri Government Relations Director for the American Cancer Society Cancer Action Network, represented the “con” side of the argument.

Want an in-depth, objective analysis of what the amendment would do? Read this story from St. Louis Public Radio’s Jo Mannies: “Rival tobacco tax proposals focus all their energies on Missouri’s Amendment 3.

Below, please find major “pro” and “con” arguments summarized.

PRO: Ron Leone wants people to vote “Yes” on Proposition A. Here are his main points:

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Ron Leone is a proponent of Proposition A
Photo credit Kelly Moffitt, St. Louis Public Radio

The Missouri Petroleum Marketers & Convenience Store Association was tired of having to fight “outrageous and unfair” tobacco taxes every 2-4 years and hopes this incrementally increasing tax will reduce the need to fight such measures and protect the MPCA.

  • By 2021, the tax will have increased 135%, which is considered “fair and reasonable” because it will keep Missouri at a competitive tax advantage over our eight border states.
  • The tax will generate $100 million, which will go toward fixing Missouri’s roads and bridges. It does not solve lack of funding for MODOT, but would help.
  • There appears to be no other transportation funding fix coming down the pike.
  • People come to Missouri to buy cigarettes and other tobacco products, which generates sales tax, tobacco tax and motor fuels tax. This tax will ensure the state’s prices stay competitive so that people from other border states will still come here and spend money.
  • The proposition has a “rollback” clause that if anyone tries to pass another tobacco tax by initiative petition, this tax will revert to zero. The MPCA did not want to pass this proposition to protect itself one year and have it undone the next.
  • If both Proposition A and Amendment 3 pass, it is unclear what will happen: either the higher tax cancels the other tax out or the taxes will be cumulative. The courts will decide.

Essentially, Ron Leone wants people to vote “Yes” on Proposition A because he thinks smaller, incremental tax increases on tobacco will keep Missouri competitive and bring spenders here from other states while also garnering money to invest in transportation infrastructure.

CON: Stacy Reliford urges a “No” vote on Proposition A. Here are her main points:

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Stacy Reliford is an opponent of Proposition A
Photo credit Kelly Moffitt, St. Louis Public Radio

  • The amount of the proposed tax increase is not designed to reduce smoking. Only bigger, more substantial tax increases of $1 or more impact consumer behavior.
  • The proposition was written by those in the tobacco industry, and those who profit from selling cigarettes and consumers’ health was not in mind.
  • This will only move Missouri to being 49th instead of 51st in cheapest cigarettes in the country and that is holding all other tobacco prices constant.
  • It does not make sense to sell cigarettes to boost the state’s economy, when cigarette use in our state costs $644 million in Medicaid alone.
  • Per the proposition’s “rollback clause,” any other tobacco tax only has to make it on the ballot to be repealed — it doesn’t even have to pass. That could cut the transportation funding right away.
  • Not knowing the complete and total outcome of what this vote means — if the tax would or would not be compounded with Amendment 3 should they both pass — is dangerous for voters to approve.
  • This proposition is really about discouraging the state from ever raising taxes on tobacco enough to dissuade consumers from buying and using them.

Essentially, Stacy Reliford wants people to vote “no” on Proposition A because the tax will not effectively dissuade consumers from purchasing and using tobacco, which has proven harmful for people’s health and costly for the state.

Want to read more pro/cons about Missouri ballot measures? Read these perspectives about Constitutional Amendment 6 and  Constitutional Amendment 4.”

2016-10-31 P-D LTE: “Amendment 3 is not what it appears to be”

St. Louis Post-Dispatch Letters to the editor, Oct 31, 2016 (12 comments)

Amendment 3 is not what it appears to be

I thought surely I was having a bad dream when I read the Post-Dispatch’s support (Oct. 24) for Constitutional Amendment 3 — the Trojan horse masquerading as a worthy source of funding for early childhood health and education programs.

Ever since 2006 when the Missouri Stem Cell Amendment was passed, I have had a good dream — a bright and hopeful dream — of research that could result in cures for diseases such as type 1 diabetes, Parkinson’s and others. But the many strings attached to this amendment could set back earlier victories that opened the way for critical medical research. The fact that it is bankrolled by R.J. Reynolds Tobacco Co. should be a clue that this is not what it appears to be.

If the Post-Dispatch is so certain that its judgment trumps that of organizations such as Washington University, the American Cancer Society, the American Heart Association and many others of equal pedigree on record opposing the amendment, could it not at least make mention that others have thoughtful and legitimate reasons to take exception — and why?

While I would never dispute the need for funding for early childhood education, it seems clear that this is not the way to do it.

I urge voters to consider other editorial voices of the state’s major newspapers who see the proposition for the sham that it is.

Marianna Riley • Webster Groves

2016 ballot tobacco tax proposals: Vote No on both

There’s a heated debate going on regarding two dueling proposals on the November 8th ballot, Constitutional Amendment 3 and Proposition A, both aimed at raising Missouri’s present lowest-in-the-nation cigarette tax. I’m personally voting “NO” on both, as explained below, but I also list pro and con reasons provided by others.

First, it’s worth comparing our state’s tax with that of surrounding states and also provide some historical perspective:

Missouri's cigarette tax versus that in 8 adjoining states

Missouri’s 17 cents per pack cigarette tax versus that in the 8 adjoining states. Average of 8 = $1.05. New York, at $4.35, is highest nationally. 
Ref: tobaccofreekids.org

The current Missouri state tax is 17 cents a pack, agreed to in a deal in 1993 between former House Speaker, Bob Griffin (who was later indicted and jailed on bribery and other charges), and the late John Britton, the formidable lobbyist for the now-defunct Tobacco Institute. The agreement was to raise the tobacco tax by 4 cents for school nurses in exchange for not raising it further. (ref: 2010/11/24 P-D OpEd:”Cigarette Taxes – Missouri can’t afford to be last” .)

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Ron Leone

Several attempts to raise it significantly, in part as a way to deter smoking and cut smoking rates in Missouri, have met resolute and successful opposition. A leading opponent is Ron Leone, Executive Director of the Missouri Petroleum Marketers and Convenience Store Association (MPCA) (www.mpca.org/) since tobacco sales are important to his members. (See, for example, this 2012 blog “Missouri keeps tobacco tax as the lowest in the nation.”)

Below are detailed descriptions of the two tobacco-related measures with commentary added:

Constitutional Amendment 3 (Raise Your Hands For Kids, aka RYH4K):  
Cigarette tax primarily funding early childhood education (at least 75% mandated), childhood health programs (10%-15%), and smoking cessation and prevention programs (5%-10%).  The additional 60 cent cigarette tax, reached after 4 years in 15 cents/year increments for a total of 77 cents, would put MO at 39th place in the current state list, ahead of neighboring NB, KY, and TN.
In addition, an equity assessment fee of 67 cents per pack is being assessed on any “Non-participating manufacturer” in the Master Settlement Agreement (MSA), inflation adjusted up each year. (This applies to the smaller tobacco companies (see below) which were not included in the MSA with states Attorney Generals, which requires substantial annual payments to the states). 
I personally believe that any increase in cigarette taxes, which should be done as a single tax hike for maximum impact and not phased in, should be targeted towards the following goals:
1. Deterring would-be smokers from ever starting by aggressive anti-tobacco advertising
2. Large enough to persuade at least some smokers to quit, and perhaps
3. Offer subsidized or free quit smoking programs.
This will ensure that over time, provided the newly-funded programs are designed to be successful, the number of Missouri smokers and tax revenue raised from cigarettes will both fall in unison.
The largest financial supporter of this amendment is R.J. Reynolds, which I surmise had a hand in writing it, such as phasing in the tax increase over four years, and especially for adding the “equity assessment fee” of 67 cents per pack on smaller tobacco companies, on top of the 60 cent increase, in hopes of putting them out of business.  Normally, tobacco companies fight tooth and nail against proposals to raise tobacco taxes, but R.J. Reynolds has to date reportedly spent over $12 million supporting this initiative.
I’m not enthusiastic about using such taxes to fund unrelated programs, however worthwhile, because then you have a new source of funding (smokers) which this new program ideally will want to maintain.
In addition, Amendment 3 prohibits any money from being spent on issues relating to abortion, stem cells, and tobacco related research, as defined below:

Section 54(b). 2. …. None of the funds collected, distributed,  or allocated from the Early Childhood Health and Education Trust Fund shall be expended, paid or granted to or on behalf of existing or proposed activities, programs, or initiatives that involve abortion services including performing, inducing, or assisting with abortions, as defined in law, or encouraging patients to have abortions, referring patients for abortions not necessary to save the life of the mother, or development of drugs, chemicals, or devices intended to be used to induce an abortion. None of the funds collected … shall be expended, paid or granted to or on behalf of any abortion clinic, abortion clinic operator, or outpatient healthcare facility that provides abortion services, unless such services are limited to medical emergencies. No funds …. shall be used for human cloning or research, clinical trials, or therapies or cures using human embryonic stem cells, as defined in Article III, section 38(d). No funds … shall be used for tobacco related research of any kind.
Many
groups oppose the Raise Your Hand for Kids amendment, including Tobacco Free Missouri. Dena Ladd, Executive Director of Missouri Cures, listed them in an October 23rd, 2016, St. Louis Post-Dispatch OpEd: Why medical research advocates are so concerned about Amendment 3.  

For balance, here’s a link to an October 20th, 2016, St. Louis Post-Dispatch OpEd in support of RYH4K by Richard Patton, director of Vision for Children at RiskMore important than the well-being of our children?
It should also be noted that the St. Louis Post-Dispatch editorial board is recommending a YES vote on both Amendment 3 and Proposition A, after flip-flopping twice on Amendment 3 earlier in the year (see Riverfront Times Sept. 27th story critical of the Post-Dispatch).

A person I respect and former Missouri House member, who now heads a local group with divided views among its members, wrote to me as follows:
 
“Members who have fought year after year for investment in early childhood education are supporting it – they are tired of waiting for our General Assembly to address our outdated, unfair, and inadequate revenue system. While the General Assembly continues to tax cut year after year – a billion dollars in cuts over the past 15 years approximately – essential programs languish, and only three percent of our children are in high quality early childhood education. We are structuring ourselves to fail in so many ways!

Members who oppose Amendment 3 generally think it’s a ploy by Big Tobacco to make more money and that the early childhood advocates are being played. Several have a hotbutton issue that turns them against 3 – the definition of abortion in the ballot measure language, fears of some slippery slope on stem cell research (an argument that I do not find persuasive), wishes for a larger tobacco tax from a “what works in comprehensive tobacco control” perspective, etc.).”

Proposition A: 

The Missouri Petroleum Marketers and Convenience Store Association (MPCA), a trade group representing many independent gas stations and convenience stores, is leading the opposition to Amendment 3 and is backing a competing – and substantially smaller – cigarette tax, phased in over four years, that will appear on the November ballot as Proposition A. Not surprisingly, it leaves in place the current exemption for any “Non-participating manufacturer” in the Master Settlement Agreement which are specifically targeted in the competing RYH4K ballot initiative.

The two major financial supporters of this proposal are reportedly North Carolina-based Cheyenne International and XCaliber International of Oklahoma. Cheyenne (Brands: Aura, Cheyenne, Decade) has sent $2.8 million to the fight, while XCaliber (Brands: Echo, Exeter, Edgefield) has contributed $2.9 million.

Under Proposition A, the additional tax on a 20 pack of cigarettes will increase over a period of four years as follows:

13-cents-per-pack on January 1st, 2017, i.e. 30 cents total state tax
An additional 5-cents-per-pack on January 1st, 2019, to 18-cents-per-pack for 35 cents total
An additional 5-cents-per-pack on January 1st, 2021, to 23-cents-per-pack for 40 cents total

These increases will not apply to inventory as of December 30th in any previous year.

In addition to leaving in place the current pricing windfall of the brands mentioned above, what renders Proposition A totally unacceptable is the following language it contains:
 
6. The additional taxes levied in subsections 1 and 2 of this section shall immediately, automatically and permanently be repealed and reduced to zero under any of the following events:
(1.) In the event any tax or fee increase on some or all cigarettes or other tobacco products is officially certified to be placed on any local or statewide ballot by the Secretary of State or any other election official at any time; or
(2.) In the event any provision of subsections of 1 through 9 of this section is ruled null and void, invalid, unlawful, severable or unconstitutional for any reason by any state or federal court of law. 
 
What this means is that if a political subdivision at any level even works to put an increase on the ballot, the state cigarette tax levied through this amendment is repealed.  This has been described as a poison pill.  There will never be an increase over this amount without this proposed increase being nullified.  
Unsurprisingly, Proposition A leaves in place the current exemption for a “Non-participating manufacturer” in the Master Settlement Agreement which is targeted in the competing RYH4K ballot initiative.